A single-center study to evaluate the efficacy of a fetal urine peptide signature predicting postnatal renal outcome in fetuses with posterior urethral valves

Pediatr Nephrol. 2020 Mar;35(3):469-475. doi: 10.1007/s00467-019-04390-9. Epub 2019 Nov 7.


Background: Posterior urethral valves (PUVs) account for 17% of pediatric renal failure. The management of pregnancies involving fetuses with PUV is hampered by the fact that current clinical parameters obtained from fetal ultrasound and/or fetal urine biochemistry are insufficient to predict postnatal renal function. We previously have developed a fetal urine peptide signature (12PUV) that predicted with high precision postnatal renal failure at 2 years of age in fetuses with PUV. Here, we evaluated the accuracy of this signature to predict postnatal renal outcome in fetuses with PUV in an independent single-center study.

Methods: Thirty-three women carrying fetuses with suspected PUV were included. Twenty-five fetuses received vesicoamniotic shunts during pregnancy. PUV was confirmed postnatally in 23 patients. Of those 23 fetuses, 2 were lost in follow-up. Four and 3 patients died in the pre- and perinatal periods, respectively. Follow-up renal function at 6 months of age was obtained for the remaining 14 patients. The primary outcome was early renal failure, defined by an eGFR < 60 mL/min/1.73 m2 before 6 months of age or pre- or perinatal death.

Results: The peptide signature predicted postnatal renal outcome in postnatally confirmed PUV fetuses with an AUC of 0.94 (95%CI 0.74-1.0) and an accuracy of 90% (95%CI 78-100). The signature predicted postnatal renal outcome for the suspected PUV cases with an AUC of 0.89 (95%CI 0.72-0.97) and an accuracy of 84% (95%CI 71-97).

Conclusions: This single-center study confirms the predictive power of the previously identified 12PUV fetal urinary peptide signature.

Keywords: Chronic kidney disease; Outcome; Prediction; Prenatal; Rare disease; Urinary proteome analysis.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anastomosis, Surgical / methods
  • Feasibility Studies
  • Female
  • Fetal Diseases / etiology
  • Fetal Diseases / surgery
  • Fetal Diseases / urine*
  • Fetal Therapies / methods
  • Follow-Up Studies
  • Humans
  • Infant
  • Infant, Newborn
  • Kidney Function Tests / methods*
  • Male
  • Peptides / urine*
  • Predictive Value of Tests
  • Pregnancy
  • Prenatal Diagnosis / methods
  • Renal Insufficiency / epidemiology*
  • Renal Insufficiency / etiology
  • Risk Assessment / methods
  • Urethra / abnormalities*
  • Urethral Obstruction / etiology
  • Urethral Obstruction / surgery
  • Urethral Obstruction / urine*
  • Urologic Surgical Procedures / methods


  • Peptides